Persistent skin colonization with Staphylococcus aureus in atopic dermatitis: relationship to clinical and immunological parameters

Summary Background Staphylococcus aureus has important implications for the pathogenesis of atopic dermatitis (AD). In some patients S. aureus can be eradicated from the skin during anti‐inflammatory treatment, while in others bacterial colonization is persistent. Potential mechanisms and features o...

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Bibliographic Details
Published in:Clinical and experimental allergy 2005-04, Vol.35 (4), p.448-455
Main Authors: Guzik, T. J., Bzowska, M., Kasprowicz, A., Czerniawska-Mysik, G., Wójcik, K., Szmyd, D., Adamek-Guzik, T., Pryjma, J.
Format: Article
Language:English
Subjects:
Administration, Topical
Adult
Allergic diseases
Anti-Allergic Agents - administration & dosage
Anti-Allergic Agents - immunology
antihistamine
atopic dermatitis
Biological and medical sciences
CD4-CD8 Ratio - methods
Cetirizine - administration & dosage
Cetirizine - immunology
Dermatitis, Atopic - complications
Dermatitis, Atopic - immunology
Dermatitis, Atopic - microbiology
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Histamine H1 Antagonists, Non-Sedating - administration & dosage
Histamine H1 Antagonists, Non-Sedating - immunology
Humans
immunoglobulin E
Immunoglobulin E - analysis
Immunopathology
Male
Medical sciences
Mometasone Furoate
Nose - microbiology
Pharynx - microbiology
Pregnadienediols - administration & dosage
Pregnadienediols - immunology
S. aureus
Skin - microbiology
Skin allergic diseases. Stinging insect allergies
Staphylococcal Skin Infections - complications
Staphylococcal Skin Infections - immunology
Staphylococcus aureus
Staphylococcus aureus - drug effects
Staphylococcus aureus - isolation & purification
steroid
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Summary:Summary Background Staphylococcus aureus has important implications for the pathogenesis of atopic dermatitis (AD). In some patients S. aureus can be eradicated from the skin during anti‐inflammatory treatment, while in others bacterial colonization is persistent. Potential mechanisms and features of these two distinct groups of patients are not known. Objective Accordingly, we studied relationships between the ability to eliminate S. aureus during an anti‐inflammatory treatment and selected clinical and immunological features. Methods Quantitative assessment of S. aureus on the skin, in nasal vestibule and throat, serum IgE levels, CD4/CD8 T‐cell ratio, lymphocyte proliferation and phagocyte oxidative burst were determined during the exacerbation and after 4 and 12 weeks of the treatment using topical steroid and oral antihistamine in 34 patients with AD. Results S. aureus was found on the skin of all 34 patients during exacerbation. Disease severity scoring of atopic dermatitis (SCORAD) correlated with the density of bacteria. Treatment with oral antihistamine and topical steroid resulted in a significant alleviation of symptoms, which correlated with the elimination of S. aureus from the skin in 70% of patients. In the remaining 30% of patients, dense (more than 1010/cm2) S. aureus skin colonization, persisted despite the treatment. Patients with persistent S. aureus presented with higher serum IgE levels, lower lymphocyte proliferation in response to staphylococcal enterotoxin B, phytohaemagluttinin and anti‐CD3. Persistence of S. aureus was more common in men. Conclusions Patients with AD differ in the ability to clear S. aureus from the skin during anti‐inflammatory treatment, which appears to be related to the abnormalities in immunological parameters. Local antibiotic therapy should be considered only in patients with persistent S. aureus colonization.
ISSN:0954-7894
1365-2222
DOI:10.1111/j.1365-2222.2005.02210.x